Should we avoid antibiotics in Jakarta? -- Opinion

Several days ago, my cousin told me about a group whose doctors are againts prescribing antibiotics to their patients. This mailing list is initiated by several pediatricians who think that antibiotic is harmful for children.

Talking about it in Jakarta context, where the air is heavily polluted and hygiene is poor, water source is dirty, trashing is very well uncontrolled, and crowded living spaces; antibiotic is believed to be necessary even for a single viral infection. 

İn western countries, nosocomial infection incidence are lower because the standard of its hospitals are mostly satisfied regarding hygiene. However, in İndonesia, one shouldn't generalize similar condition as a "should have been the same with". İn hospitals in the US for example, even in government hospital you won't see patients family members sleep over at the patient's room altogether. Thus, cross contamination is less likely to happen. On the contrary, most government hospitals patients in Indonesia would love to bring their family members along with them. The more the merrier, even though the patient is unconcious, or even in coma state, all family members would force themselves to come along and stay at the hospital for the sake of togetherness until the patient is discharged. Since they have poor financial situation, they cannot afford to rent a room at a hotel or other places nearby. Thus, they'll usually sleep under patient's bed or at ward corridor on the floor, giving it a hard time for the nurses and docs to reach the patient for regular examination.

Referring to that situation, as a medical doctor, would you consider to risk you patients by not prescribing antibiotics as prophylaxis in the treatment plan? İ wouldn't. İt is understood if unnecessary medication may lead patients to other risk of drug resistants or allergy, however, you would not prefer to risk your patients of having nosocomial infections or secondary infection, due to lack of hygiene and cross contamination, either.

İn terms of ambulatory care, in addition, it is common to prescribe antibiotics to almost every diagnosis in Puskesmas. Again it is because the health providers doubt the hygiene behavior at patients' house.

İt is not guaranteed that patients will generally be avoided from secondary bacterial infection if doctor does not prescribe antibiotics on every infectious disease he meets.

Perhaps, patients who came from middle to upper social class who are believed to live in more hygienic environment would be okay without unnecessary antibiotic regimen in their prescription. These people, who are usually well educated, formally and non formally, are more skeptical to any medical  information/terms that they just heard of, and cooperated well with doctor's instructions.